[Hiring] Preservice Review Nurse RN @UnitedHealth Group

Role Description

Positions in this role are responsible for Women’s Health/ Gender Dysphoria/ Genetics clinical reviews and require a current, unrestricted RN nursing license in the applicable state. Individual is responsible for performing pre-service clinical coverage review of outpatient Women’s Health/ Gender Dysphoria/ Genetics services which require notification or requested pre-determination, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria.

If you reside in TN, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Perform clinical reviews, which require decision making related to interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information.
• Ability to make appropriate clinical decisions within a business environment.
• Serve as a member of a team with specific individual and team performance metrics.
• Communicate in writing and verbally, all forms of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations.
• Work independently and collaboratively with Medical Directors and other business partners.
• Flexibility to adapt to changing environment and varied case volume.
• Other duties as assigned by leadership.

Qualifications

• Active, unrestricted Registered Nurse license through the State of Tennessee.
• 3+ years of RN patient care experience.
• Proficiency working with Microsoft Office Products including Microsoft Outlook, Microsoft Word, and Microsoft Excel.
• Reside in Tennessee.

Requirements

• Bachelor's degree (preferred).
• Background involving utilization review or experience in case management, or previous experience with clinical claim review (preferred).
• Familiarity with utilizing clinical guidelines (i.e.; Medicare, state, MCG or InterQual) (preferred).
• Proven solid clinical judgement while applying medical necessity based on approved clinical resources (preferred).

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).
• Hourly pay for this role will range from $29.00 - $52.00 per hour based on full-time employment.